Town of Framingham. Health Insurance Update. Board of Selectmen. January 30, 2007

Transcription

1 Town of Framingham Health Insurance Update Board of Selectmen January 30, 2007

2 The Employees/Retirees 2,792 Active Employees (includes seasonal/part time/temp) 788 Town Employees 559 Full Time 110 Part Time (60 benefits eligible) Remaining are temporary 1400 Retirees 2,004 School Employees 1344 Full Time 660 Part Time* (60 benefits eligible) *Includes temporary 800 Town Retirement 600 Mass Teachers Retirement Board 3423 Active and Retiree Benefit Eligible Individuals 3340* Actual Plans purchased *Includes spouses of Retirees

3 The Plans Blue Care Elect Replaced Master Medical 75% Town Paid 25% Employee Paid Monthly Cost: I=$1,085.44; F=$2, Enrollment: Town Active: 4 Ind (Plans) School Active: 10 Ind 10 Fam Town Retiree: 14 Ind 4 Fam School Retiree: 49 Ind 6 Fam

4 MEDEX Retiree Plan Only Individual Plans 75% Town Paid 25% Retiree Paid Monthly Cost: $ Enrollment: 561 Town Retirees 424 School Retirees

5 Blue Choice Primarily for those not living in MA 80% Town Paid 20% Employee Paid Monthly Cost: I=$602.51;F=$1, Enrollment: Town Active: 7 Ind 23 Fam School Active: 56 Ind 72 Fam Town Retiree: 26 Ind 26 Fam School Retiree: 43 Ind 21 Fam

6 HMO Blue Most popular plan 90% Town Paid 10% Employee Paid Monthly Cost: I=$470.39;F=$1, Enrollment: Town Active: 143 Ind 381 Fam School Active: 379 Ind 660 Fam Town Retiree: 58 Ind 83 Fam School Retiree: 85 Ind 70 Fam

7 Fallon Enrollment is frozen 90% Town Paid 10% Employee Paid Monthly Cost: I=$726.14;F=$ Enrollment: 7 Individual Plans; 17 Family Plans Fallon Senior Same contribution rates Monthly Cost: I= $ Enrollment: 26 Individual Plans

8 Blue Care 65 Retiree HMO 90% Town Paid 10% Retiree Paid Monthly Cost: I=$ Enrollment: Town: 25 Plans School: 22 Plans Carveout A Medicare Supplement Plan 75% Town Paid 25% Retiree Paid Monthly Cost: $ Enrollment: 28 Plans

9 Rate History: HMO - Rate & % Increase POS - Rate & % Increase $288 $ % $ 754 $ % $370 $ % $ 970 $1, % $380 $395 $ % 3.95% 10.38% $ 993 $1,034 $1, % 4.13% 10.16% $495 $516 $ % 4.24% 10.08% $1,299 $1,353 $1, % 4.16% 10.20% 2007 $ % $1, % 2007 $ % $1, % INDEM/PPO - Rate & % Increase $ $1,575 - $ % $1, % 2004 $ % $2, % 2005 $ % $2, % 2006 $1, % $2, % 2007 $1, % $2, %

10 Contribution Rate Comparison from MMPA Benchmarking Survey 2006 HMO PPO Indem/PPO Ashland 75-83% 50% 50% Beverly Braintree Brookline 75 n/a n/a Cambridge 88 n/a 99 Dedham Framingham n/a Malden n/a Marlborough n/a Natick n/a Needham n/a Newton n/a Norwood n/a Peabody Plymouth n/a n/a 80 Somerville 90 n/a 99 Southborough 80 n/a 50 Sudbury n/a Waltham 90 n/a 92.5 Worcester

11 Municipal Utilization

12 Financial Analysis Demographics Average Subscriber Age has fallen to 51 from 52 in 2003, six years older than the Network Average Network Average is 45 Average Member Age has gone from 39.7 to 39.6 over the past three years Network Average is 35.4 Average Contract Size has remained 2.1 for the past three years Network Average is also 2.1

13 Product Composition HMO/POS Traditional/PPO Both

14 Office Visit Copay $5 $10 Plus $5 $10 $15 $20 Plus

15 ER Copay $25 $50 Plus $25 $50 Plus

16 Rx Retail Copay 2 Tier 5/10/25 10/20/35 10/25/45 Other 3 Tier

17 Financial Analysis Utilization Member Cost Share Office Visit Utilization 15% 19% Network Averages 6/05-5/06 6% 7% 5% 3% Average

18 16.3% -13% 26,377,647 22,688, % 153,930, ,296,714 Average 25% 9% 112,175, ,076, % 443,682, ,004,205 Worcester 8% 4% 9,320,826 8,944, % 115,095, ,313,010 Weymouth 11% -100% 8,822, % 81,386,331 Wellesley 9% 12% 4,295,154 3,840, % 50,490,411 49,030,202 Wayland 25% 24% 32,794,465 26,374, % 128,688, ,684,784 Waltham 26% -100% 31,657, % 123,828,032 Taunton 18% 16% 12,053,214 10,373, % 68,568,627 62,534,755 Sudbury 29% -100% 42,144, % 143,108,187 Somerville 14% -100% 29,571, % 211,433,119 Quincy 13% -100% 16,868, % 126,599,606 Plymouth 14% -100% 14,299, % 100,883,438 Peabody 28% 94% 68,487,398 35,387, % 242,619, ,679,847 Newton 10% 14% 8,734,490 7,688, % 85,648,273 78,546,892 Needham 10% 15% 8,795,455 7,668, % 90,943,398 85,649,963 Natick 17.0% 16% 14,136,553 12,136, % 83,246,257 80,998,315 Marlborough 16.9% 21% 18,789,332 15,590, % 111,276, ,702,012 Malden 11% 12% 26,008,295 23,260, % 231,124, ,657,267 Lynn 18.4% 23% 38,132,028 30,991, % 207,642, ,870,134 Lawrence 14.0% 4.5% 24,294,940 23,243, % 173,228, ,661,632 Framingham 10% 15% 36,519,221 31,619, % 350,916, ,913,505 Cambridge 10% -5.0% 16,540,379 17,402, % 169,025, ,148,059 Brookline 21% -6.8% 18,167,869 19,486, % 87,673,925 85,458,096 Beverly 8% 18% 3,466,161 2,930, % 40,959,241 37,772,138 Ashland 25% 5% 22,086,654 21,134, % 89,918,800 93,257,616 Arlington % of Total % Ch FY2006 FY2005 % Ch FY2006 FY2005 Municipality Health Insurance Total Spending General Fund Budget Comparison

19 Average Wayland Wellesley Weymouth Worcester Brookline Cambridge Framingham Lawrence Lynn Malden Marlborough Natick Needham Newton Peabody Plymouth Quincy Somerville Sudbury Taunton Waltham Beverly 30% 25% 20% 15% 10% 5% 0% Health Insurance as a % of Total Budget Arlington Ashland

20 Total Health Insurance Trust Fund Balance $1,000,000 $500,000 $- $(500,000) $(1,000,000) $(1,500,000) $(2,000,000) $(2,500,000) $(3,000,000) FY2002 FY2003 FY2004 FY2005 FY2006

21 FY2005 Trust Fund Balance Components $12,991 Employer Fund Employee Fund $86,880

22 FY2006 Trust Fund Balance Components $20,377 Employer Fund Employee Fund $762,361

23 History of Coalition Bargaining August 1993: The Town of Framingham and Public Employee Committee enter into an agreement establishing Coalition Bargaining as the process by which to negotiate present and future changes to the group health benefits offered to employees, retirees and survivors. Coalition Bargaining is conducted according to M.G.L. 32B, S19. Under Coalition Bargaining, a Public Employee Committee (PEC) is formed representing a member from each bargaining unit and a retiree. This PEC negotiates all aspects of the town s health plans with the town s negotiating agent.

24 August/Sept. 1993: First agreement under Sec.19 is reached between the Town and the Public Employee (PEC). This agreement was unanimously passed by the PEC and saved the Town a projected 1.2 million dollars. Agreement Covered Jan Dec.1995)

25 April 1996 Second agreement covering Jan.1, 1994 Dec.31, No changes. Dec New agreement covering Jan December Health Insurance Review Committee was established. Master Medical Plan was frozen and no new members were excepted unless they moved out of state or were approved by the Health Review Committee. The established form of Medicare B reimbursement was discontinue and a new one was put into place saving the Town money in this and ALL future agreements.

26 Nov.2002 New agreement covering January 1, 2002 December 31, Once agreement was signed, PEC agreed to transfer $300,000 to Town Trust to help compensate for the significant increase in the stop-loss insurance. For calendar years 2003 and 2004, it was agreed that $1 per week per individual health contract would be moved from the employee trust fund to the Town of Framingham. For calendar years 2003 and 2004, the employees paid 100% of their dental premium saving the Town $250,000

27 Sept New agreement covering Jan. 1, 2005 Dec. 31, Master Medical plan was eliminated and replaced with Blue Care Elect. For the calendar year 2005, the employee trust fund paid thetown $1.25 for each health insurance contract in force plus extended the previous $1 per contract to total $2.25 per contract for the 2005 calendar year. Extended 100% cost of dental to employee.

28 Sept New agreement covering January 2006 Dec. 31, For the calendar year , the employee trust fund will pay the Town of Framingham $3.00 per week for each health insurance contract in force. Changes in co-pays for Office visits and Emergency Room visits for HMO Blue Plan and Point of Service Plan (Blue Choice). Three tier prescription plan adopted and increased co-pays. Increased annual contribution to Reimbursement program increased and Town assumed 15% of dental premium. An opt out plan was provided. This agreement represents a projected savings of over 1.4 million.